Breast Reduction Mammoplasty Research Articles

Cancer-specific alterations in nuclear matrix proteins determined by multi-omics analyses of ductal carcinoma in situ.

Breast cancer (BC) is the most common cancer affecting women in the United States. Ductal carcinoma in situ (DCIS) is the earliest identifiable pre-invasive BC lesion. Estimates show that 14 to 50% of DCIS cases progress to invasive BC. Our objective was to identify nuclear matrix proteins (NMP) with specifically altered expression in DCIS and later stages of BC compared to non-diseased breast reduction mammoplasty and a contralateral breast explant culture using mass spectrometry and RNA sequencing to accurately identify aggressive DCIS. Sixty NMPs were significantly differentially expressed between the DCIS and non-diseased breast epithelium in an isogenic contralateral pair of patient-derived extended explants. Ten of the sixty showed significant mRNA expression level differences that matched the protein expression. These 10 proteins were similarly expressed in non-diseased breast reduction cells. Three NMPs (RPL7A, RPL11, RPL31) were significantly upregulated in DCIS and all other BC stages compared to the matching contralateral breast culture and an unrelated non-diseased breast reduction culture. RNA sequencing analyses showed that these three genes were increasingly upregulated with BC progression. Finally, we identified three NMPs (AHNAK, CDC37 and DNAJB1) that were significantly downregulated in DCIS and all other BC stages compared to the isogenically matched contralateral culture and the non-diseased breast reduction culture using both proteomics and RNA sequencing techniques. These genes should form the basis of, or contribute to, a molecular diagnostic panel that could identify DCIS lesions likely to be indolent and therefore not requiring aggressive treatment.

Shifts in Reduction Mammaplasty Surgical Volumes With the Emergence of a Global Pandemic.

The onset of the COVID-19 pandemic resulted in significant changes to the surgical caseload for various surgery departments across the United States. As medical institutions prioritized resources for the expected increase in patient volumes due to the SARS-CoV-2 viral infection, surgical departments saw a decrease in nonemergent and elective surgical procedures. Reduction mammoplasties, which are largely covered by insurance, are among the elective procedures that provide significant revenue to the hospital. This expected decline in procedures suggests a potential decline in revenue provided by the plastic surgery department of a hospital. The purpose of this study was to analyze the loss of revenue experienced by a single academic medical institution due to changes in breast reduction mammoplasty volumes during the COVID-19 pandemic. Upon institutional review board approval, using the Augusta University Medical Center's Financial Billing Data, 373 patients who underwent bilateral reduction mammoplasty were queried. A time horizon of March 2019 to February 2022 was used to determine the pre- and post-COVID case load and charges that were incurred. Statistical analysis to compare the prior 12 months and after 24 months of COVID was conducted using 2 samples of equal variance t test and F test confirming equal variance. There was a statistically significant increase in the number of reduction mammoplasties performed per month from the year before the onset of COVID-19 (March 2020) to the 2 years after (6.6-11.4 per month, P = 0.0024). There was a statistically significant increase in the per-month charges from the AU Health system for reduction mammoplasties for the same period ($31,780.92-$52,113.34 per month, P = 0.0054). Although there was an increase in per-month revenue from reduction mammoplasties, this increase failed to reach statistical significance ($7,059.95-$10,423.51 per month, P = 0.064). The plastic surgery department saw a statistically significant increase in reduction mammoplasty cases and subsequent charges in the post-COVID cohort. These findings suggest that the emergence of a nationwide pandemic did not necessarily lead to a decrease in the volume of nonemergent surgical cases despite an expected decrease in caseload due to the need to reallocate hospital resources. On the contrary, there was an increase in caseload suggesting that there may be other factors contributing to patients' pursuance of reduction mammoplasty post-COVID including convenience, resulting from time off due to pandemic, meeting insurance-covered reduction criteria, and projected recovery time.

Abstract 1750: Decoding breast cancer: Unraveling subtype and model differences through multi-model single-cell RNA sequencing data integration

Abstract Breast cancer's complex transcriptional landscape requires a deep understanding of sample and cell diversity to identify effective treatments. In this study, we amalgamate single-cell RNA sequencing data from breast cancer patient-derived xenografts (PDX), organoids, cell lines, patient tumors and reduction mammoplasties resulting in a comprehensive dataset of 117 samples with 506,719 total cells. These samples encompass hormone receptor positive (HR+), human epidermal growth factor receptor 2 enriched (HER2E), and triple-negative breast cancer (TNBC) subtypes. We aimed to delineate similarities and distinctions across model systems and patient samples while also exploring stratification of therapeutic drug efficacy based on subtype proportions within tumors. Mammary tumor PDXs, organoids, and established cell lines exhibited higher proliferation and lower heterogeneity observed via UMAP dimensionality reduction compared to most patient tumors or normal breast epithelium. TNBCs had elevated proliferative and pro-metastatic signatures compared to HR+ and HER2E samples. Interestingly, compared to matched PDX tumors, organoids from these same models were found to exhibit stark differences in gene expression, including upregulation of metabolically active aldo-keto reductase family genes, highlighting differences in the model systems with implications for pre-clinical drug testing. Single-cell tumor subtyping analyses with scSubtype and TNBCtype methods found that therapeutically treated samples had shifts in the proportions of cell-wise subtype annotations when compared to matched untreated samples. Similarly, patient lymph node metastasis when compared with matched primary tumors were significantly linked to decreases in Basal-like and HER2-enriched cell-wise annotations in untreated ER+ samples. In vitro assessment of anti-cancer compounds on PDX cells showed significant correlation of subtype proportion with cell viability following treatment with targeted therapeutic agents. This subtyping methodology offers a powerful tool to monitor the evolving gene expression landscape within samples and predict responses to therapeutic agents. We present here a dynamic approach to cell-wise sample annotation and a substantial multi-model dataset for use facilitating informed decision-making in preclinical research and therapeutic development. Citation Format: Julia E. Altman, Carson J. Walker, Emily K. Zboril, Nicole S. Hairr, Rachel K. Myrick, David C. Boyd, Jennifer E. Koblenski, Madhavi Puchalapalli, Bin Hu, Mikhail G. Dozmorov, Xi Chen, Yunshun Chen, Charles M. Perou, Brian D. Lehmann, Jane E. Visvader, Amy L. Olex, J. Chuck Harrell. Decoding breast cancer: Unraveling subtype and model differences through multi-model single-cell RNA sequencing data integration [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1750.

Abstract C035: Impact of South Florida environmental chemicals on breast cells derived from women of different ancestries

Abstract Breast Cancer (BC) occurrence is due to an interplay of ancestry-based and environmental factors. In order to study BC disparities in South Florida, our group initially focused on 7 Broward County zip codes where the proportion of BC identified at late stage is much higher (55%) than the national average (30-35%), and where there is a high percentage of people of African Ancestry (AA). Thus, we are investigating the interaction of ancestry and the environment in BC. Our hypothesis is that there are unique environmental sensitivities leading to BC that are associated with specific ancestral groups. We expect that some of the carcinogenic chemicals that cause BC may cause more advanced or aggressive BC in AA women. We are studying 2 environmental pollutants, one in water (arsenic) and one in soil (glyphosate) that are prevalent in S. Florida, and these local zip codes, and analyze the specific impact of these pollutants on unique breast reduction mammoplasty cultures derived from women of AA vs. Non-Hispanic White (NHW) ancestry. We have developed a unique tissue engineering system for non-diseased breast that allows us to establish cultures with high success (95%) using a stem cell-based medium and Matrigel. From primary cultures, we have established 38 extended explants (<13 passages) or cell lines (>13 passages). 10 are from AA women and 28 are from women of NHW ancestry, thus far with Hispanic samples in the works. We hypothesize that these groups will show significant differences in their gene expression patterns after exposure to environmental carcinogens. We have previously shown that there is a significantly higher proportion of breast stem cells in AA cultures (N=5) compared with the NHW cultures (N=5) (p= 0.028). This difference in size of the stem cell compartment may help to explain why the age of breast development in these two groups is significantly different and why their subtypes of BC are different based on ancestry. We are using 5 AA and 5 NHW breast reduction mammoplasty cultures, as well as stem cells derived from them, to test arsenic and glyphosate for their ability to alter the transcriptome of these cells using RNA sequencing. Analyses of gene expression using both supervised and unsupervised strategies will be performed (KEGG Pathways and single genes). We expect to see changes that are consistent with pre-invasive malignancy that have been established in endocrine disruptor studies. Because our group is one of the few that has successfully cultured stage 0 BC (Ductal Carcinoma In Situ), we have existing databases of transcriptomic changes from 6 DCIS cell lines as well as from 6 stage I BC cell lines for comparison. Preliminary data from the Nanostring BC360 and RNA sequencing show 8 genes involved in DNA damage and repair that are downregulated in AA breast reduction mammoplasty explants relative to NHW explants. This study will fill an important void in our understanding of how the environment affects pre-cancerous development in specific demographic populations. Citation Format: Jean J. Latimer, Yousef N. Alharbi, Colton R. Simmons, Stephen E. Zimberg, Essie K. Yates. Impact of South Florida environmental chemicals on breast cells derived from women of different ancestries [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C035.

Evaluating the Impact of ACGME Resident Duty Hour Restrictions on Patient Outcomes for Bilateral Breast Reductions.

Bilateral breast reductions performed in the 3 years before and after each reform were collected from the National Inpatient Sample database: pre-duty hours (2000-2002), duty hours (2006-2008), and extended duty hours (2012-2014). Multivariable logistic regression models were constructed to investigate the association between ACGME duty hour restrictions on medical and surgical complications. Overall, 19,423 bilateral breast reductions were identified. Medical and surgical complication rates in these patients increased with each successive iteration of duty hour restrictions (P < 0.001). The 2003 duty-hour restriction independently associated with increased surgical (OR = 1.51, P < 0.001) and medical complications (OR = 1.85, P < 0.001). The 2011 extended duty-hour restriction was independently associated with increased surgical complications (OR = 1.39, P < 0.001). ACGME duty-hour restrictions do not seem associated with better patient outcomes for bilateral breast reduction although there are multiple factors involved. These considerations and consequences should be considered in decisions that affect resident quality of life, education, and patient safety.

Expanding Candidacy for Nipple-sparing Mastectomy in Women with Large or Ptotic Breasts: Staged Reconstruction Outcomes.

We performed a retrospective chart review of all patients who underwent reduction mammoplasty followed by NSM at our institution between January 2014 and September 2020. Clinical and surgical characteristics were collected. All surgical complications, including NAC loss rates, were analyzed. Forty-one patients (74 breasts) underwent staged NSM during the defined time period. The average time between breast reduction mammoplasty and NSM was 213 days. Overall, 94.6% of NSM resulted in successful nipple preservation. There was no significant difference in the time interval from breast reduction mammoplasty to NSM between patients who had NAC loss (208 days) and those who did not (213 days, P = 0.87). Increasing age was significantly associated with risk of NAC loss (P = 0.002) in our cohort. In women with breast ptosis (which precludes safe NSM), it is possible to first offer reduction mammoplasty to preserve the NAC for future NSM. Our data suggest that 3 months between staged procedures is a safe time frame.

556 Case Report: Diagnosis of Bilateral PASH (Pseudoangiomatous Stromal Hyperplasia) in an 11-Year-Old Female

Abstract PASH (Pseudoangiomatous stromal hyperplasia) is a rare pathological finding, defined as a benign mesenchymal proliferative lesion of the breast, presenting more frequently in premenopausal women. Although benign, differentiation from low grade Angiosarcoma due to their histological similarities. Management guidelines for PASH remain primitive due to the rarity in diagnosis and reporting of such cases. We present a very interesting case of an 11-year-old female assessed for her rapidly enlarging breasts. Initial management entailed right breast reduction Mammoplasty due to the presumed diagnosis of Macromastia. Histopathological assessment of the specimen initially reported the presence of Fibroadenoma. However, re-assessment by a senior Pathologist subsequently diagnosed the lesion as Pseudoangiomatous Stromal Hyperplasia (PASH). Further MRI imaging of both breasts revealed multiple, large, bilateral lesions. All identified bilateral breast lesions were excised, with a cumulative weight of 1.6 Kg, combined with WISE pattern reduction of the right breast overlying skin was carried out in due course. There has been no previous reporting of PASH in an 11-year-old female, which itself is a rare condition. Further studies on PASH are recommended to reduce the risk unnecessary surgical management of such cases due to misdiagnosis.

Comparing oncoplastic breast reduction with immediate symmetry surgery to standard breast reduction surgery: Are postoperative complications worse?

Oncoplastic breast reduction mammoplasty (ORM) is an excellent treatment option for women with breast cancer and macromastia undergoing breast conservation therapy. Here, we aim to better understand the risks associated with ORM compared to standard reduction mammoplasty (SRM). A retrospective chart review was performed of patients undergoing ORM or SRM from 2015 to 2021. Primary outcomes included the occurrence of major or minor postoperative complications in the two groups and delays to adjuvant therapy (>90 days) among the women undergoing ORM. Women in the ORM group (n = 198) were significantly older (p < 0.001) with a higher prevalence of smoking (p < 0.001), diabetes mellitus (p < 0.01), and a Charlson comorbidity index ≥ 3 (p < 0.001) compared to women undergoing SRM (n = 177). After controlling for potential confounders, there were no significant between-group differences in the odds of developing postoperative complications (odds ratio = 0.80, 95% confidence interval: 0.36-1.69). Only 3% (n = 4) of the 150 women undergoing adjuvant radiation or chemotherapy experienced delays related to postoperative complications. ORM has a similar safety profile as SRM, despite the older age and higher number of comorbidities often seen in patients undergoing ORM, and is a safe option for achieving contralateral symmetry at the time of partial mastectomy without delays to adjuvant therapy.

Postoperative Prophylactic Antibiotic Use in Breast Reduction Mammoplasty: A Single Centre Retrospective Cohort Study.

Introduction: Breast reduction mammoplasty (BRM) is a common procedure performed by plastic surgeons treating patients with hypermastia. It is customary to give preoperative prophylactic intravenous antibiotics for BRM, followed by several days of postoperative prophylactic oral antibiotics, despite the lack of evidence of their effectiveness in preventing surgical site infections (SSIs). The purpose of this study is to determine if the addition of prophylactic postoperative antibiotics is more effective in preventing SSIs in comparison to a single dose of preoperative prophylactic antibiotics in BRM. Methods: A retrospective analysis of 124 elective BRM cases by a single senior plastic surgeon was completed. Two study groups were formed based on the location of surgery and each group was assigned a different antibiotic regimen. The first antibiotic regimen consisted of a single preoperative intravenous dose of antibiotics (group 1), while the second regimen consisted of a preoperative intravenous dose followed by a 5-day course of oral antibiotics (group 2). Results: Overall SSI rate was 5.6%. Infection rate in group 1 was 8.1% in comparison to 3.2% for group 2 (P value .44). Overall, the incidence of complications was 29.0%; 38.7% in group 1 and 19.4% in group 2 (P value .03). Complications consisted of 35 cases of delayed wound healing, 7 SSIs and 2 hematomas requiring evacuation. Conclusion: Study results demonstrated that the use of postoperative prophylactic antibiotics for BRM had no significant effect on the rate of SSIs.

Abstract A033: Identification of cancer-specific alterations in expression of nuclear matrix proteins through proteomic and RNAsequencing analyses of ductal carcinoma in situ

Abstract Background and Objectives: In 2021 breast cancer (BC) was the most common cancer affecting women and the second deadliest cancer in the U.S. Ductal Carcinoma In Situ (DCIS) is the earliest identifiable pre-invasive breast cancer lesion. Approximately 20-25% of diagnosed breast cancer cases are ductal carcinoma in situ (DCIS). Estimates show that 14 to 50% of DCIS cases progress to invasive breast cancer. We used a novel tissue-engineering system established in the Latimer laboratory to generate model systems representative of different molecular and histological subtypes of all stages of BC, including DCIS. Using a mass spectrometry (MS)-based relative quantitative methodology, we analyzed one novel DCIS cell line, the matching isogenic contralateral cell line and the non-tumor adjacent cell line, as well as two non-diseased breast reduction mammoplasty cell lines and the established stage IV BC cell lines MCF7 and MDA MB231. RNA sequencing analysis included additional cell lines from stages I, II and III. In order to limit the number of proteins for proteomic assessment, nuclear matrix proteins (NMPs) were targeted for analysis. NMPs have previously been linked with cancers of the prostate, colon, and breast. Maldi-TOF/TOF-MS analysis identified 270 NMPs with high confidence. Our objective was to identify NMPs with specifically altered expression in DCIS and later stages of BC compared to non-diseased breast and contralateral breast. Such markers may help to accurately identify invasive DCIS and improve early detection of BC. Results: We identified two nuclear matrix proteins that are significantly downregulated in DCIS and all other stages of BC in our collection. This downregulation was also apparent through mRNA expression analysis. These proteins are upregulated in non-diseased breast reduction tissue and contra-lateral DCIS derived from the same patient. We also identified four NMPs that were significantly upregulated in DCIS and all other BC stages compared to non-diseased breast reduction tissue and contralateral DCIS. Gene expression analyses showed that these four genes were upregulated with BC progression. Finally, we identified nine NMPS with significant differences in expression between DCIS and all stages of BC versus non-diseased breast reduction tissue and contralateral DCIS where gene expression did not follow the same trend as proteomic analysis. Conclusion: Our findings suggest that the changes that occur in the nuclear matrix of DCIS vs. normal breast epithelium could provide a basis for the development of prognostic biomarkers for DCIS and allow for targeted prevention of progression to invasive disease. This work was supported by grant W81XWH-0701-0660 from the DOD CDMRP BC program. Citation Format: Ali Almutairy, Abdullah Alhamed, Stephen G. Grant, Miranda Sarachine Falso, Billy W. Day, Jean J. Latimer. Identification of cancer-specific alterations in expression of nuclear matrix proteins through proteomic and RNAsequencing analyses of ductal carcinoma in situ [abstract]. In: Proceedings of the AACR Special Conference on the Evolutionary Dynamics in Carcinogenesis and Response to Therapy; 2022 Mar 14-17. Philadelphia (PA): AACR; Cancer Res 2022;82(10 Suppl):Abstract nr A033.

Effect of intraoperative blood pressure on incidence of hematoma in breast reduction mammoplasty

Postoperative hematomas are among the most frequent complications following breast reduction mammoplasty (BRM). Intraoperative hypotension has been implicated in the development of postoperative hematomas following breast reduction. In this study, we performed a retrospective, propensity-matched analysis of patients undergoing primary breast reduction to determine the relationship between intraoperative blood pressure and the development of a postoperative hematoma. A retrospective review of all patients that underwent BRM at a single institution from 2017 to 2019 (n=563) was conducted. Patients who developed a postoperative hematoma were propensity matched to two controls based on body mass index (BMI) and age. The mean systolic blood pressure (SBP) and average mean arterial pressure (MAP) were recorded for each third of the operation. Data were analyzed using conditional logistic regression. Thirty-two patients that developed postoperative hematomas were propensity matched to 64 controls. There was no difference in baseline SBP, diastolic blood pressures, or prevalence of hypertension between groups. There was no significant difference in average SBP or MAP between groups. The average MAP during the first third of the procedure was found to be lower in patients who developed a hematoma (69vs. 72mmHg), which approached significance at p=0.08. Closed suction drains were used in 53% of the hematoma group and 78% of the control group (p=0.02). There does not appear to be an association between intraoperative blood pressure and the incidence of hematoma when comparing patients who developed hematomas after BRM to propensity-matched controls.

Atypical Hyperplasia Found Incidentally during Routine Breast Reduction Mammoplasty: Incidence and Management.

Background:Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) of the breast are premalignant lesions. Although the literature on ADH and ALH as a whole is well-developed, research on ADH and ALH incidentally discovered during breast reduction is less robust.Methods:In this study, 355 patients undergoing bilateral reduction mammoplasty at West Virginia University were retrospectively reviewed. A variety of demographic and clinicopathologic variables were collected for each patient, and the incidence of atypical hyperplasia was calculated. Four patients (1.13%) were found to have atypical hyperplasia, three ALH, and one ADH, which is within the range reported in the literature. For patients incidentally found to have atypical hyperplasia, an in-depth analysis of postoperative management was performed.Results:Of the four patients with atypical hyperplasia, three were referred to a cancer center, and one patient followed only with plastic surgery. The three patients who were referred to a cancer center saw a breast surgeon, whereas the patient followed only by plastic surgery did not. None of the four patients received anti-estrogen therapy, but each patient who followed with a cancer center was offered treatment and declined.Conclusions:As a relatively uncommon finding with complex management guidelines, atypical hyperplasia discovered on breast reduction should be referred to a cancer center for long-term follow-up and management when possible. Further research is needed to assess if the management of atypical hyperplasia discovered incidentally after routine reduction should mimic treatment of atypical hyperplasia found after biopsy for suspicion of malignancy.

Abstract P2-11-03: Menstrual phase classification of benign breast tissue using hormone-regulated gene expression and morphology

Abstract Introduction: The use of archived benign breast samples (BBS) for breast cancer risk research is limited by the fact that menstrual luteal phase and menopausal status is either unknown or inaccurate by self-report. As a result, physiologic variation in gene and protein expression cannot be accounted for. We previously showed that morphologic features (PMID: 12481017) and progesterone (P)-related gene expression (PMID: 23512947) in breast specimens can aid in luteal phase classification. Here we report a validation of the concept, in a larger sample size, regarding gene expression, menstrual-specific morphology factors and a combination of both. Methods: BBS were obtained from the contralateral unaffected breast (CUB) of unilateral breast cancer patients and reduction mammoplasty (RM) controls of premenopausal women (n = 81) under IRB approved protocol. Gene expression analysis was performed with 100 ng by qRT-PCR of 21 target genes. Serum concentration of estradiol (E), P, and follicular stimulating hormone (FSH) were measured by enzyme immunoassay and IMMULITE. Subjects were classified using hormone levels as postmenopausal (E&amp;lt; 30 pg/ml and FSH&amp;gt; 30 IU/L) or luteal phase (E&amp;gt;60pg/ml and P&amp;gt;3ng/ml); premenopausal women who did not meet luteal phase hormonal criteria were called non-luteal. A single study pathologist evaluated samples from premenopausal subjects, masked to the menstrual phase of subjects, using histo-morphologic features to categorize subjects as luteal or non-luteal. Gene expression and morphology were evaluated individually and together, through multivariate analysis, for luteal-phase stratification. Receiver operator curve (ROC) analysis was used to assess the accuracy (AUC) for prediction of luteal phase using gene expression, morphology and a combination of both. Results: Our study population, matched by age, included 81 premenopausal subjects (CUB=51, RM=30) with mean age of 42. For luteal phase classification, we identified P-correlated genes; TNFSF11, DI02, and MYBPC1 genes were significantly correlated with serum progesterone levels. ROC analysis results using individual genes, average morphology score and multivariate model is in the table below. The results are reported with the area under the curve (AUC) value along with the confidence interval. The multivariate model consists of the three genes with the average morphology score. Conclusions: We provided preliminary validation for three P-related genes as classifiers of luteal phase status. We find that histomorphologic classification of menstrual phase is more prominent in the RM samples. These findings along with our validation data, for the first time, provide RNA-based classifiers for menstrual phase of BBS, and offer the potential of increasing the robustness and validity of biomarker research by accounting for important physiologic variation in the hormonal milieu of the donor. CUB (n = 51) AUC +/- ciRM (n = 30) AUC +/- ciTNFS11 gene expression0.84 (0.74 – 0.95)0.76 (0.54 – 0.97)DI02 gene expression0.86 (0.75 – 0.96)0.72 (0.49 – 0.96)MYBPC1 gene expression0.80 (0.68 – 0.92)0.67 (0.45 – 0.89)Average morphology score0.67 (0.54 – 0.81)0.87 (0.76 – 0.98)Multivariate model0.89 (0.79 – 0.98)0.948 (0.87 -1.00) Citation Format: Omid Hosseini, Irene Helenowski, Oukseub Lee, Hui Zhang, Jun Wang, Luis Blanco, Seema A Khan. Menstrual phase classification of benign breast tissue using hormone-regulated gene expression and morphology [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-03.

Postoperative pain and opioid use after breast reduction with or without preoperative nerve block

Physician-prescribed opioids have been implicated as key contributing factors in the current opioid epidemic in the United States. Breast reduction mammoplasty is one of the most commonly performed procedures in plastic surgery and patients are often prescribed large amounts of postoperative opioids. Here we investigate the effects of erector spinae nerve blocks on postoperative pain, opioid consumption, and quality of life after breast reduction.Following the institutional review board (IRB) approval, a prospective cohort study of some patients undergoing breast reduction mammoplasty at Montefiore Medical Center between June and September 2019 was undertaken. The patients were stratified into two cohorts for further analysis: those who received preoperative erector spinae nerve block and those who did not. Primary outcomes measures analyzed included Likert pain scores, patient-reported outcome measures, and opioid consumption for the first five postoperative days.Forty-seven patients were enrolled in the analysis. Thirteen patients (28%) received nerve blocks, 34 (72%) did not. On average, the patients were prescribed 114.3 (±34.6) morphine equivalents postoperatively and they consumed 45% (±35.3) by the end of the first five days post-surgery. There were no significant differences between cohorts in morphine equivalents prescribed or consumed, postoperative pain scores, or patient-reported outcome measures.Following breast reduction mammoplasty, patients on average consumed < 50% of prescribed opioids, suggesting over-prescription of postoperative opioids for breast reduction recovery. Preoperative nerve block did not improve pain scores or decrease opioid consumption for the first five days after surgery.

Automated Breast Volume Assessment Derived From Digital Breast Tomosynthesis Images Compared to Mastectomy Specimen Weight and Its Applications in Cosmetic Optimisation.

Background: Estimating the size and volume of the breast preoperatively is an important step in surgical planning for many breast procedures such as immediate implant-based breast reconstructions and reduction mammoplasties. Breast volume estimation helps in appropriate implant selection preoperatively.Objectives: The aim of this study was to objectively evaluate the estimation of breast weight by automatic volumetric breast assessment in digital breast tomosynthesis (DBT) using Quantra™ 2.2 Breast Density Assessment Software (Hologic Inc., Marlborough, Massachusetts, United States). Methods: Breast specimen weight after mastectomy and volume estimated by Quantra software were recorded.Results: Volume assessment obtained from Quantra software showed a high correlation with actual mastectomy specimen weight, with Pearson’s correlation coefficients of 0.952.Conclusions: The automated DBT-derived breast volume using the Quantra software is a simple and practical method to assess breast size and weight preoperatively.

Effect of Language Barriers and Need for Interpreter Services on Breast Reduction Mammoplasty Outcomes

Shah, Jinesh MD; Yi, Joseph BS; Ni, Jason BA; Kest, Joshua MD; Greige, Nicolas MD; Ricci, Joseph MD Author Information

A CASE REPORT OF BILATERAL BREAST REDUCTION MAMMOPLASTY CRISIS IN KUWAIT: MEDICAL MALPRACTICE OR POSTOPERATIVE COMPLICATION

Background: bilateral breast reduction mammoplasty is a popular cosmetic surgical operation. Patients usually aim to bring down the volume of the breast to achieve har-monious to their build along with overcoming the inconvenience caused by enormous, ill-shaped and suspended breasts. As the aesthetic appearance performs major im-portance in this procedure, a minimum of scar load is usually predicted, and the tech-nique used must be individualized. However, preserving sensation and breastfeeding, especially during the child-bearing period, are also crucial. Complications are to be predicted in reduction mammoplasty; however, various post-operative complications were recorded because of errors of judgement, faulty surgical plan, and imprecise im-plementation of the plan. While plastic surgeons experience one of the highest per-centages of physicians facing a malpractice claim, the unexpected cosmetic result pre-sents the evident complaint. Objective and method: discussion of a case of a medical malpractice claim of post-operative bilateral necrosis resulted in total excision of the nipple-areola complex (NAC) along with the underlying tissue in both breasts. Medi-cal and operative history details of the patient were discussed against the surgical pro-cedure and the surgeon’s decision. The result is to understand the reason behind the catastrophic result and the management of the medicolegal claim to reach the prove of the medical litigation due to faulty surgical decision and management. Conclusion: most complications can be avoided with proper history taking, selection of the appro-priate operation for the given patient and proper post-operative complications han-dling.

Reducing pain and opioid consumption after body contouring of the breast by application of a perioperative nerve block: a systematic review.

BackgroundPain in the postoperative body contouring patient has traditionally been managed with narcotic medication. In an effort to minimize side effects and prevent addiction, plastic surgeons are searching for novel ways to provide adequate analgesia, one of which is nerve blocks. This study was conducted with a meta-analysis that evaluates the efficacy of these blocks for patients who undergo breast surgery.MethodsA search of the PubMed/MEDLINE database for articles including the terms “postoperative analgesia” OR “postoperative pain management” AND “in plastic surgery” OR “in cosmetic surgery” OR “in elective surgery” in February 2019 generated five studies on elective breast augmentation and reduction mammoplasty that reported pain scores and quantities of opioids consumed. Independent samples t-tests, one-way analysis of variance, and a random effects model were implemented for evaluation.ResultsA total of 317 patients were identified as having undergone body contouring of the breast, about half of which received a nerve block. Pain scores on a 1–10 scale and opioid dose-equivalents were calculated. Those who were blocked had an average score of 2.40 compared to 3.64 for those who did not (P<0.001), and required an average of 5.20 less narcotic doses (P<0.001). Pain relief following subpectoral augmentation was best achieved with type-II blocks as opposed to type-I and type-II with serratus plane (P<0.001).ConclusionsThe opioid epidemic has extended to all surgical specialties. Implementation of a nerve block seems to be an efficacious and cost-effective mechanism to not only help with postoperative pain, but also lower the need for narcotics, especially in subpectoral augmentation.

Effect of Reduction Mammoplasty on Pulmonary Function Tests: A Systematic Review.

In patients with breast hypertrophy, excessive breast weight applies pressure on the thorax, which may disrupt the normal breathing. The purpose of this study is to evaluate the impact of the breast hypertrophy and reduction mammoplasty on respiratory function. A comprehensive search of 3 databases, PubMed, Ovid, and Scopus databases, was performed. "Mammoplasty" and "respiration or pulmonary function tests" were the keywords used to search for relevant articles. Ten studies involving 280 patients with breast hypertrophy were included in the final review. Seven articles demonstrated an increase in at least 1 pulmonary function test value after the surgery. This systematic review revealed that, preoperatively, pulmonary function test values of the patients are usually in the normal range. Nonetheless, reduction mammoplasty still improves lung function parameters. Additionally, patients with respiratory complaints felt improvement in their symptoms after the surgery. However, future studies are needed, as heterogeneity among studies was observed.

Do larger reductions yield larger returns? patient-reported outcomes as a function of specimen weight in bilateral reduction mammoplasty

BackgroundPatients undergoing breast reduction mammoplasty for symptomatic macromastia have a significantly improved quality of life postoperatively. However, there are no data that examine the effect of reduction mammoplasty on quality of life as a function of the weight of tissue removed. Because the process by which insurance providers consider patients’ candidacy for this breast reduction mammoplasty is most often based on the proposed weight of tissue to be removed, this gap in our understanding is particularly glaring. We therefore designed a prospective trial with the intent of investigating the correlation between breast reduction specimen weight and postoperative pain and quality of life. MethodsAfter obtaining institutional review board (IRB) approval, patients presenting for breast reduction mammoplasty at a single academic medical center between January 2016 and September 2019 were prospectively enrolled in the study. Study participants completed the Numerical Pain Rating Scale (NPRS), the short-form McGill Pain Questionnaire (SF-MPQ), and the BREAST-Q at set time points (preoperatively, 1 week/1 month/3 months/6 months postoperatively). Patients were divided into three cohorts based on breast reduction specimen weights: small (<500 g reduction), intermediate (500–1000 g reduction), and large (>1000 g reduction). The surveys were then analyzed while controlling for demographic factors and complications. ResultsA total of 85 women were enrolled in the study and completed pre- and postoperative surveys (small reduction n = 21 (25%), intermediate n = 45 (53%), and large n = 19 (22%)). Regardless of reduction specimen weight, patients reported decreased overall pain and increased satisfaction with their breasts, as well as improved psychosocial, sexual, and physical well-being at each postoperative visit. Preoperative SF-MPQ pain scores were significantly lower in the small specimen weight group compared with either the intermediate or the large group (p = 0.001). Postoperatively, both the intermediate and large groups reported significant improvement in pain at each time point. The small specimen weight group did not report significant pain improvement until 3 months postoperatively. ConclusionsPatients undergoing breast reduction mammoplasty experience decreased pain and improved quality of life regardless of reduction specimen weight. Improvement in these parameters manifests as early as 1 week postoperatively and maintained at 3 months postoperatively. These data suggest that many patients who are denied coverage for reduction mammoplasty on the basis of low projected reduction specimen weight would derive significant benefit from the procedure.